Utilization Management Administration Coordinator – SNF

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🖥️ Administration

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Provides non-clinical support for policies ensuring appropriate treatment, care, or services for members • Works fully remote and collaborates with the nursing team • Manages NLP's for chart reviews • Builds and pends authorizations for review • Performs inbound and outbound calls to engage providers and members • Verifies clinical information, discharge date, and admission status • Documents completed calls and attaches clinical information received • Requests clinical information from providers/facilities • Creates written correspondence and determination letters

🎯 Requirements

• 1+ years' experience working in an administrative support capacity • Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data • Ability to learn new systems (proficient to advanced) • Experience with Utilization Review or Prior Authorization within a managed care organization (preferred) • Proficient using electronic medical record and documentation programs (preferred) • Experience with medical terminology or ICD-10 codes (preferred) • Prior member service or customer service telephone experience (preferred) • Experience with SNF or Home Health (preferred) • Prior experience with CGX, SRO and HCHB (preferred) • Prior experience in a metric driven environment (preferred) • Prior experience in the healthcare industry (preferred)

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities